New Mexico Taxation and Revenue Department
                      Application for Refund of Tax 
                    Withheld From Pass-Through Entities
When To Use this Form: Use this form to apply for a refund of withholding tax on the net income of a pass-through entity (PTE) *447480200*
reported on PTE New Mexico Information Return for Pass-Through Entities or an overpayment of tax withheld on RPD-41367, 
Pass-Through Entity Withholding Detail (PTW-D) Report; Fiduciary Pass-Through Withholding Detail (FID-D) Report;                                                  or PTW-EXT,New 
Mexico Annual Withholding of Net Income From a Pass-Through Entity Detail Report Extension Payment Voucher. To obtain a refund of 
tax, complete this form and mail it to the Department at P.O. Box 25127, Santa Fe, New Mexico 87504-5127. For assistance, call (505) 
827-0825 or toll free at (866) 285-2996. 
Name of pass-through entity (PTE)                                PTE’s FEIN                    Line 1. Total New Mexico net income

                                                                       Beginning of tax year                                                                  Last day of tax year
PTE’s tax year. (Enter the first and last day of the tax year.)
                                                                 MM    DD    CCYY                                                                               MM    DD    CCYY
Contact name                                                                                               Phone number                          Email address

I hereby certify that the State of New Mexico was overpaid the sum of                                                  $                                      for withholding tax 

pursuant to the Oil and Gas and Pass-Through Entity Withholding Tax Act, for the tax year ending                     

Basis for Refund 
Enter the reason for the overpayment. 

                                         Request For Direct Deposit
                                                                                             Required: Will this refund go to or 
  1.  Routing number:                                                                        through an account located outside 
                                                                                             the territorial jurisdiction of the United 
  2.  Account number:                                                                        States? If yes, you may not use this refund 
                                                                                             delivery option. 
  3.  Type:         Checking           Savings                          4.     Required:                   Yes                                                          No

  I declare that the information reported on this form and any attached supplements is true and correct.

  Signature of taxpayer or agent ________________________________________  Title  ______________________  Date ____________________

  Type or print name ____________________________________ Phone ______________________ E-mail address ___________________________

                                   New Mexico Taxation and Revenue Department
        Application for Refund of Tax Withheld From Pass-Through Entities
                                                 Instructions

Who May Use This Form. A pass-through entity (PTE)                 To Claim a Refund for Tax Withheld on a PTE Return
may use RPD-41373, Application for Refund of Tax                   If you received a 1099-MISC, RPD-41359, Annual 
Withheld From Pass-Through Entities, to request a refund           Statement of Pass-Through Entity Withholding, or RPD-
of tax withheld from its net income according to the Oil           41285, Annual Statement of Withholding of Oil and Gas 
and Gas Proceeds and Pass-Through Entity Withholding               Proceeds, showing income tax withheld on the PTE’s net 
Tax Act. If tax was withheld from the net income received          income or withholding on New Mexico oil and gas proceeds 
from another PTE, or if tax was withheld from oil and gas          received, and you want a refund of the tax withheld, do the 
proceeds received, the PTE may request a refund or pass            following:
the tax withheld to its owners.                                       Enter the refund amount on the PTE return. 
                                                                   1. 
You may also use RPD-41373 to apply for a refund if you            2. If you want direct deposit of your refund, complete the 
overpaid withholding tax from a PTE owner’s allocable net             RPD-41373 Request For Direct Deposit section. If the 
income on RPD-41367, Pass-Through Entity Withholding                  information is incomplete or incorrect, the Department 
Detail (PTW-D) Report; Fiduciary Pass-Through                         mails the refund. 
Withholding Detail (FID-D) Report; or PTW-EXT, New                 3. The PTE’s owner or the PTE’s authorized representative 
Mexico Annual Withholding of Net Income From a                        signs RPD-41373.
Pass-Through Entity Detail Report Extension Payment 
                                                                   4. Attach the completed RPD-41373 to the PTE return and 
Voucher.
                                                                      submit them to the Department at the address below.
About Direct Deposit. A direct deposit of your refund may          5. Issue to the PTE forms 1099-MISC, RPD-41359, or RPD-
not go to a bank account located at a financial institution           41285. 
outside the territorial jurisdiction of the United States          To Claim a Refund for Overpayment on a PTW-D or 
(U.S.). A financial institution is located within the territorial  FID-D PTW Detail Report, or a PTW-EXT Voucher 
jurisdiction of the U.S. if it is located within the U.S., located If you overpaid the tax to withhold from a PTE owner’s 
on a U.S. military base, or located in American Samoa,             allocable net income on the PTW or FID-D PTW detail 
Guam, the Northern Mariana Islands, Puerto Rico, or the            report or on PTW-EXT, do the following:
U.S. Virgin Islands. 
                                                                   1. On RPD-41373, under Basis for Refund, explain the 
To comply with federal banking rules, anyone who wants                reason for overpayment with a brief statement of facts. 
a refund directly deposited must answer an additional                 If you need more space, attach another sheet. 
question when completing the Request For Direct                    2. If you want direct deposit of your refund, complete the 
Deposit section of this application for a tax refund. The             RPD-41373 Request For Direct Deposit section. If the 
question asks whether the refund will go to, or through,              information is incomplete or incorrect, the Department 
an account located outside the territorial jurisdiction of the        mails the refund. 
U.S.                                                                  The PTE’s owner or the PTE’s authorized representative 
                                                                   3. 
                                                                      signs RPD-41373.
If Yes, RPD-41373 states, “ ... you may not use this refund 
delivery option.” Your other options are to use a different        4. Attach the completed RPD-41373 to the PTW or FID-D 
bank account or to leave the Request for Direct Deposit               PTW detail report and submit them to the Department. 
section blank, in which case the Department mails a paper 
                                                                   IMPORTANT: To validate the claim for refund on a PTW-D 
check to the address on the taxpayer’s records.
                                                                   or FID-D PTW detail report, the Department may require 
                                                                   you to file both the appropriate income tax return and the 
If you do not answer the question, the Department also 
                                                                   detail report. The Department compares the information 
mails your refund to you as a paper check. Answering the 
                                                                   provided on both forms to verify the validity of the refund 
question incorrectly may delay your refund, or the National 
                                                                   claim.
Automated Clearing House Association (NACHA) or the 
Office of Foreign Assets Control (OFAC) may reject or 
freeze your refund. 

                                New Mexico Taxation and Revenue Department
                                                 P.O. Box 25127
                                                 Santa Fe, NM 87504-5127